The Inclusion of Activities of Daily Living in Flexor Tendon Rehabilitation

Abstract

s / Journal of Hand Therapy 27 (2014) e1ee9 e7 estimationof theodds ratio foranypredictor thatwere identified from the studies included for Meta-analysis. The effect sizes were then analysed using the comprehensive meta-analysis software. Results: Forty two articles met our inclusion criteria to be included in thefinal reviewout ofwhich fourteen studieswere included in the meta-analysis. Fatty infiltration was found to be a significant predictor of outcomes after RCR. Factors such as tear size, pre-operative strength of the rotator cuff muscles, multiple tendon involvement, presence of workman’s compensation status showed modest effect on functionand cuff integrityafter RCR. Age had amodest effect on cuff integrityandno significant effect on functional outcomesafter surgery. Variables such as trauma and duration of symptoms before surgery hadno significant effect on outcomes after surgery. Several of these factorswere studied inonly2 cohorts andneed future studies to validate their effect. Gender, pre-operative range of motion in shoulder, pre-operative muscle atrophy and pre-operative muscle pain reduction after lidocaine injection were studied in only one cohort each and thus were not considered in this analysis. Conclusion: Using a rigorous process for the identification and extraction of data fromahomogenous subset of prognostic rotator cuff repair literature and statistical analysis using comprehensive metaanalysis software,wewere able to identify several predictors forwhich information is easy to collect clinically and could provide clinicians with ameaningful feedback on prognosis following rotator cuff repair. The Inclusion of Activities of Daily Living in Flexor Tendon Rehabilitation RHONDA POWELL , REBECCA VON DER HEYDE 1 Occupational Therapy Program, Maryville University, St. Louis, MO, USA Milliken Hand Rehabilitation Center, The Rehabilitation Institute of St. Louis, St. Louis, MO, USA Purpose: The purpose of this study was to measure hand therapists’ attitudes and behaviors pertaining to ADL assessment and intervention following flexor tendon repair. Background: A limitation in ADL performance as a result of upper extremity injury has been previously studied with patients following traumatic injuries, flexor tendon repairs, and extensor tendon repairs (Gustaffson, Persson, & Amilon, 2000; Gustaffson & Ahlstrom, 2004; Kaskutas & Powell, 2013). Patients in these studies reported difficulty with ADLs, including dressing, toileting, meal preparation, and driving. Due to such limitations in ADL performance, researchers have suggested that hand therapists should assume a more intentional role in prioritizing these issues (Sandford, Barlow, & Lewis, 2008; Bell, Gray, & Kingston, 2011). In an attempt to better appreciate the perspectives of practicing hand therapists towards ADL assessment and intervention following flexor tendon repair, the current study was initiated. Methods: A 21-item open survey link was e-mailed to all members of the American Society of Hand Therapists (ASHT) who have an email address on record. The survey included questions on therapists’ demographics, annual volume of flexor tendon patients, general involvement with ADL assessment and intervention, and feedback through comments. It was conducted online and made available for six weeks. A reminder email was sent mid-way through the survey period to facilitate survey completion. Results: The survey yielded a 91% completion rate, with 530 participants opening the survey and 481 finishing it. Quantitative results of the survey indicated that the majority of hand therapists (97.5%) feel that ADL performance is an important part of hand therapy practice and that teaching adaptive strategies is a high priority in the early weeks of flexor tendon rehabilitation, but less than half (45.5%) actually provide an in-depth assessment of ADL performance. From a qualitative perspective, therapists as surveyed in this study indicated a general perception that formal ADL assessment and/or intervention may not be necessary for patients in the acute phase following flexor tendon repair. In addition, therapists discussed a perceived limitation of time in therapy and alternate assessments/intervention as taking priority over ADLs. A third theme alluding to the importance of incorporating ADL into hand therapy practice was also noted, commensurate with the quantitative findings. Conclusion: Flexor tendon rehabilitation has historically focused on biomechanical issues and not on how patients are coping with performance of ADL in the post-operative phase. The results of this survey demonstrate that therapists feel that ADL assessment and training is an important aspect of hand therapy during the first four weeks following flexor tendon repair, but that time restrictions, lack of access to standardized ADL assessments, and a perceived lack of need for formal intervention may prevent many therapists from providing this intervention. Baseline Predictors of Self-Reported Pain and Disability After Two Years in Patients Who Underwent Biceps Tendon Repair JOSHUA I. VINCENT , JOY C. MACDERMID 2,3,4 Department of Health and rehabilitation Sciences, University of Western Ontario, London, ON, Canada Hand and Upper Limb Center, St. Joseph’s Healthcare London, London, ON, Canada Department of Surgery, University of Western Ontario, London, ON, Canada 4 School of Rehabilitation Science, McMaster University, Hamilton, ON,